Infected Ruptured Pseudo-aneurysm in Descending Aorta; a Case Report.

Aortitis is the inflammation of the aortic wall. It can be caused by both infectious and non-infectious etiologies. Mycotic aneurysm is a rare, serious medical condition and typically requires prompt treatment with antibiotics, surgical intervention, or endovascular procedures to prevent rupture and complications. Here we reported, a 66-year-old male patient with a medical history of diabetes and hypertension, who presented to the emergency department (ED) with left-sided hemiplegia. Brain magnetic resonance imaging (MRI) revealed infarction in the right parietooccipital and left occipital lobes, demonstrating an embolic pattern. laboratory analysis revealed elevated levels of erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and white blood cell (WBC). In order to investigate the possibility of sepsis, a non-contrast chest computed tomography (CT) scan was performed, which showed a soft tissue density surrounded by gas in the posterior mediastinum; for which the rupture of esophagus and infected aorta pseudoaneurysm were among differential diagnoses. To confirm the diagnosis, CT angiography was ordered. The infected ruptured pseudo-aneurysm(s) was confirmed and patient underwent thoracotomy surgery.

Language Abnormalities in Alzheimer's Disease Arise from Reduced Informativeness: A Cross-Linguistic Study in English and Persian.

INTRODUCTION: This research investigates the psycholinguistic origins of language impairments in Alzheimer's Disease (AD), questioning if these impairments result from language-specific structural disruptions or from a universal deficit in generating meaningful content. METHODS: Cross-linguistic analysis was conducted on language samples from 184 English and 52 Persian speakers, comprising both AD patients and healthy controls, to extract various language features. Furthermore, we introduced a machine learning-based metric, Language Informativeness Index (LII), to quantify informativeness. RESULTS: Indicators of AD in English were found to be highly predictive of AD in Persian, with a 92.3% classification accuracy. Additionally, we found robust correlations between the typical linguistic abnormalities of AD and language emptiness (low LII) across both languages. DISCUSSION: Findings suggest AD linguistics impairments are attributed to a core universal difficulty in generating informative messages. Our approach underscores the importance of incorporating biocultural diversity into research, fostering the development of inclusive diagnostic tools.

Ultrasound shear-wave elastography applicability in estimation of post-mortem time.

Introduction: Post-mortem rigidity of the tissues is one of the basic principles in forensic medicine to estimate the time of death. Qualitative methods to determine the stiffness of the corpse may have some limitations. Methods that provide quantitative values may be useful. We intended to evaluate the applicability of ultrasound shear-wave elastography of the tissues to estimate the post-mortem interval (PMI). Methods: For 80 corpses, shear-wave elastography of the liver, sartorius muscle, testis, thyroid and parotid was performed before autopsy. Based on the forensic reports as the reference method to define post-mortem interval, the corpses were divided into four groups: group 0 (PMI < 24 hours), group 1 (PMI ≥24 hours and <48 hours), group 2 (PMI ≥ 48 hours and <72 hours), and group 3 (PMI ≥ 72 hours). There were 24, 38, 13, and 5 corpses, respectively, in groups 0, 1, 2, and 3. Results: A significant rise in the elasticity values in comparison to elasticity of normal tissues in live adults was seen very early in the post-mortem period. Between-group comparisons showed that a significant difference in the liver elasticity was present among the groups. The mean (SD) liver elasticity was 10.29 (±0.83) in group 0, 14.98 (±1.56) in group 1, 12.49 (±1.09) in group 2, and 15.64 (±1.68) kilopascals (kPa) in group 3 (P = 0.035). Nevertheless, elasticity measurements in other tissues were not helpful in distinguishing post-mortem interval groups. Conclusion: It is possible to use liver quantitative shear-wave elastography to estimate the time of death.

Fetal corpus callosum abnormalities: Ultrasound and magnetic resonance imaging role.

The corpus callosum (CC) is the major interhemispheric commissure and its abnormalities include agenesis, hypoplasia, and hyperplasia. The CC anomalies are typically related to other central nervous system (CNS) or extra-CNS malformations. The antenatal diagnosis of complete CC agenesis is easy after mid-trimester by ultrasound (US) even in the axial plane. The non-visualization of cavum septum pellucidum and colpocephaly are critical signs in the axial view. More subtle findings (i.e., hypoplasia and partial agenesis) might also be recognized antenatally. In this review, the focus was given on the prenatal diagnosis of CC abnormalities in US and magnetic resonance imaging.

Clinical target segmentation using a novel deep neural network: double attention Res-U-Net.

We introduced Double Attention Res-U-Net architecture to address medical image segmentation problem in different medical imaging system. Accurate medical image segmentation suffers from some challenges including, difficulty of different interest object modeling, presence of noise, and signal dropout throughout the measurement. The base line image segmentation approaches are not sufficient for complex target segmentation throughout the various medical image types. To overcome the issues, a novel U-Net-based model proposed that consists of two consecutive networks with five and four encoding and decoding levels respectively. In each of networks, there are four residual blocks between the encoder-decoder path and skip connections that help the networks to tackle the vanishing gradient problem, followed by the multi-scale attention gates to generate richer contextual information. To evaluate our architecture, we investigated three distinct data-sets, (i.e., CVC-ClinicDB dataset, Multi-site MRI dataset, and a collected ultrasound dataset). The proposed algorithm achieved Dice and Jaccard coefficients of 95.79%, 91.62%, respectively for CRL, and 93.84% and 89.08% for fetal foot segmentation. Moreover, the proposed model outperformed the state-of-the-art U-Net based model on the external CVC-ClinicDB, and multi-site MRI datasets with Dice and Jaccard coefficients of 83%, 75.31% for CVC-ClinicDB, and 92.07% and 87.14% for multi-site MRI dataset, respectively.

Fast and Accurate U-Net Model for Fetal Ultrasound Image Segmentation.

U-Net based algorithms, due to their complex computations, include limitations when they are used in clinical devices. In this paper, we addressed this problem through a novel U-Net based architecture that called fast and accurate U-Net for medical image segmentation task. The proposed fast and accurate U-Net model contains four tuned 2D-convolutional, 2D-transposed convolutional, and batch normalization layers as its main layers. There are four blocks in the encoder-decoder path. The results of our proposed architecture were evaluated using a prepared dataset for head circumference and abdominal circumference segmentation tasks, and a public dataset (HC18-Grand challenge dataset) for fetal head circumference measurement. The proposed fast network significantly improved the processing time in comparison with U-Net, dilated U-Net, R2U-Net, attention U-Net, and MFP U-Net. It took 0.47 seconds for segmenting a fetal abdominal image. In addition, over the prepared dataset using the proposed accurate model, Dice and Jaccard coefficients were 97.62% and 95.43% for fetal head segmentation, 95.07%, and 91.99% for fetal abdominal segmentation. Moreover, we have obtained the Dice and Jaccard coefficients of 97.45% and 95.00% using the public HC18-Grand challenge dataset. Based on the obtained results, we have concluded that a fine-tuned and a simple well-structured model used in clinical devices can outperform complex models.

Diagnostic performance of lung ultrasound compared to CT scan in the diagnosis of pulmonary lesions of COVID-19 induced pneumonia: a preliminary study.

Chest CT scan is currently used to assess the extent of lung involvement in patients with the coronavirus disease 2019 (COVID-19). The aim of this study was to evaluate the diagnostic performance of lung ultrasound in the diagnosis of COVID-19 pulmonary manifestations in comparison to CT scan. Thirty-three symptomatic patients with suspected COVID-19 pneumonia were evaluated by lung ultrasound and then, at a short interval, chest CT scan. In the anterior chest, each hemithorax was divided into four areas. In the posterior chest, eight zones similar to the anterior part were examined. The axillary areas were also divided into upper and lower zones (20 zones were determined per patient). Mean age of the patients was 58.66 years. The sensitivity (95% CI) and specificity (95% CI) of lung ultrasound for the diagnosis of parenchymal lesions were 90.5% (69.6-98.8%) and 50% (21.1-78.9%), respectively. In the evaluation of pleural lesions, the sensitivity (95% CI) and specificity (95% CI) of lung ultrasound were 100% (71.5-100%) and 22.7% (7.8-45.4%), respectively. Owing to the high sensitivity of ultrasound in identifying lung lesions in patients with COVID-19 pneumonia, it can be recommended to use lung ultrasound as a tool for initial screening of patients with high clinical suspicion for SARS-CoV-2 infection during the pandemic. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s13337-021-00736-w.

Parenteral Anticoagulation and Retroperitoneal Hemorrhage in COVID-19: Case Report of Five Patients.

Since coronavirus disease 2019 (COVID-19) is associated with a hypercoagulable state, especially in critical patients, anticoagulation is used for thromboprophylaxis. Hemorrhagic complications, even uncommon ones such as retroperitoneal hemorrhage, can occur following anticoagulant administration. We present 5 patients with COVID-19 whose clinical course was complicated by spontaneous retroperitoneal hemorrhage. The patients were initially presented with respiratory manifestations of the infection. There was no history or evidence suggestive for traumatic injury. After hospitalization, the patients received supplemental oxygen, antibiotics, enoxaparin or heparin, interferon beta-1b (in three patients), and anticoagulation with subcutaneous injection of enoxaparin (three patients) or heparin (two patients). During the course of hospitalization, the patients showed sudden-onset abdominal pain (three cases), hypotension (three cases), and an acute drop in hemoglobin level. CT scan of the abdomen and pelvis revealed retroperitoneal hemorrhage. For one patient, owing to unstable vital signs and an expanding hematoma, surgical intervention was performed. Others were managed conservatively with discontinuation of anticoagulants, intravenous (IV) fluid resuscitation, and packed red blood cells transfusion. Three patients died due to worsening of the infection and respiratory failure. Retroperitoneal hemorrhage could be a potential complication in COVID-19 patients receiving anticoagulation. Careful monitoring of the vital signs and blood tests like hemoglobin level of such patients is essential.

Automatic fetal biometry prediction using a novel deep convolutional network architecture.

PURPOSE: Fetal biometric measurements face a number of challenges, including the presence of speckle, limited soft-tissue contrast and difficulties in the presence of low amniotic fluid. This work proposes a convolutional neural network for automatic segmentation and measurement of fetal biometric parameters, including biparietal diameter (BPD), head circumference (HC), abdominal circumference (AC), and femur length (FL) from ultrasound images that relies on the attention gates incorporated into the multi-feature pyramid Unet (MFP-Unet) network. METHODS: The proposed approach, referred to as Attention MFP-Unet, learns to extract/detect salient regions automatically to be treated as the object of interest via the attention gates. After determining the type of anatomical structure in the image using a convolutional neural network, Niblack's thresholding technique was applied as pre-processing algorithm for head and abdomen identification, whereas a novel algorithm was used for femur extraction. A publicly-available dataset (HC18 grand-challenge) and clinical data of 1334 subjects were utilized for training and evaluation of the Attention MFP-Unet algorithm. RESULTS: Dice similarity coefficient (DSC), hausdorff distance (HD), percentage of good contours, the conformity coefficient, and average perpendicular distance (APD) were employed for quantitative evaluation of fetal anatomy segmentation. In addition, correlation analysis, good contours, and conformity were employed to evaluate the accuracy of the biometry predictions. Attention MFP-Unet achieved 0.98, 1.14 mm, 100%, 0.95, and 0.2 mm for DSC, HD, good contours, conformity, and APD, respectively. CONCLUSIONS: Quantitative evaluation demonstrated the superior performance of the Attention MFP-Unet compared to state-of-the-art approaches commonly employed for automatic measurement of fetal biometric parameters.

Clinical Significance of Diffusion-weighted Magnetic Resonance Imaging on Treatment Efficacy in MS Patients With Acute Attacks.

Introduction: Despite various imaging methods, the accurate diagnosis of numerous neurodegenerative diseases remains controversial. Using advanced imaging techniques, like diffusion-weighted imaging, can help the early detection of Multiple Sclerosis (MS) and evaluation of the treatment efficacy in these patients. Methods: In total, 24 MS patients with acute attack and 30 healthy subjects were considered in our study. Region of Interest (ROI) was defined for acute and chronic plaques and Normal-Appearing White Matter (NAWM) in the patients' group. In the normal group, ROI only was mapped in the white matter in the same regions of the patient. All MS patients were receiving Methylprednisolone for 3 to 5 days. The rate of clinical disability in these patients was also evaluated based on the Expanded Disability Status Scale (EDSS) index. Finally evaluate changes of ADC values of plaques and NAWM before and after treatment. Results: The Apparent Diffusion Coefficient (ADC) values of acute plaques, the ADC values of NAWM, the number of enhancement in T1w, and EDSS values suggested a significant difference after treatment compared to before treatment. However, the ADC values of chronic plaques revealed no significant difference after treatment. There was a significant positive correlation between the difference in EDSS values before and after treatment. Conclusion: The study results demonstrated that using diffusion technique and ADC values analysis is a proper non-invasive method for MS diagnosis and evaluating treatment efficacy in these patients. Highlights: The obtained results suggested that the mean ADC for acute plaques and normal white matter significantly decreased after methylprednisolone treatment.Our study indicated a strong correlation between variations in EDSS, the mean ADC for acute plaques, and normal white matter.The collected results indicated that the number of enhanced plaques decreased after treatment. Besides, there was a positive correlation between its variations and EDSS. Plain Language Summary: Multiple Sclerosis (MS) is a common inflammatory disorder of the central nervous system that could result in physical and mental disabilities in patients. Disease progression usually manifests as a series of attacks. Although there is no proven cure for MS, different treatment strategies aim to modify the cause of the disease, manage its symptoms, and prevent and postpone disability. The most common therapy in acute attacks is using corticosteroid drugs. In addition to the treatment, evaluating the success rate of treatment was also challenging. Historically, clinical assessments method (e.g. EDSS) have been used as the baseline for measuring the therapy's efficiency. Several supplementary methods, including imaging techniques, are introduced to address this issue. Conventional MRI imaging with injection has been widely accepted to assess the treatment. However, because of the modest sensitivity of conventional MRI to detect subtle pathological changes, there is a poor correlation between its findings and patients' disability. This study moved from conventional MRI to advanced techniques, such as DWI and its quantitative index named ADC value. This technique can provide information about microstructural changes in MS patients. This method does not require injection, so there are no probable adverse effects and lower scan time. This study emphasizes changes in ADC value and EDSS before and after treatment with methylprednisolone. Our results suggested s that ADC values and EDSS after treatment are significantly different from their typical values. ADC values can be used as a biomarker to evaluate treatment efficiency, yet it is not objective enough to use it alone. So, the combination of DWI imaging with conventional methods might be beneficial in assessing treatment efficiency in MS patients.

Epicardial adipose tissue, inflammatory biomarkers and COVID-19: Is there a possible relationship?

BACKGROUND & AIMS: Adipose tissue is a biologically active organ with pro-immunogenic properties. We aimed to evaluate the prognostic value of epicardial adipose tissue (EAT) in COVID-19 and its correlation with other inflammatory biomarkers. MATERIAL AND METHODS: One-hundred patients with COVID-19 were enrolled. C-reactive protein (CRP), lactate dehydrogenase (LDH), neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-CRP ratio (LCR), and platelet-to-lymphocyte ratio (PLR) were evaluated on admission. EAT volume and density were measured by computed tomography. Patients were followed until death or discharge. Univariate and multivariate analysis was performed and ROC curve analysis was used to assess the ability of inflammatory markers in predicting survival. The relationship between EAT and other inflammatory markers was also investigated. RESULTS: The mean ± SD age of patients was 55.5 ± 15.2 years old; 68% were male. Univariate analysis revealed that increased lung involvement, blood urea nitrogen, LDH and NLR, and decreased platelet count were significantly associated with death. After adjustment, LDH was independently predictive of death (OR = 1.013, p-value = 0.03). Among inflammatory markers, LCR had the best ability for predicting survival with 79.7% sensitivity and 64.3% specificity at an optimal cut-off value of 20.8 (AUC = 0.744, 95% CI = 0.612-0.876, p-value = 0.004). EAT volume demonstrated positive correlation with NLR and PLR (p = 0.001 and 0.01), and a negative correlation with LCR (p = 0.02). EAT density was significantly different between decedents and survivors (p = 0.008). CONCLUSION: Routine laboratory tests that represent status of inflammation can be used as cost-effective prognostic markers of COVID-19. Also, the significant association between EAT volume and other inflammatory biomarkers might explain the more severe disease in obese patients.

Diagnostic performance of apparent diffusion coefficient (ADC) for differentiating endometrial carcinoma from benign lesions: a systematic review and meta-analysis.

To determine the diagnostic performance of mean ADC values in the characterization of endometrial carcinoma (EC) from benign lesions by systematic review of the literature and performing meta-analysis. A systematic search of major electronic bibliographic databases was performed to find studies that used ADC values for differentiating EC from benign lesions. Two reviewers independently screened the titles and abstracts of the search results and then by reading the full texts selected the pertinent studies for final analyses. A bivariate random-effects model with pooled sensitivity and specificity values with 95% CI (confidence interval) was used. Summary receiver operating characteristic (SROC) curve and area under curve (AUC) were created. Between-study heterogeneity was measured using I squared (I2) index. Eleven studies including 269 ECs and 208 benign lesions were analyzed. Pooled average (95% CI) ADC in EC and benign lesions groups were, respectively, 0.82 (0.77-0.87) × 10-3 mm2/s and 1.41 (1.29-1.52) × 10-3 mm2/s. The combined (95% CI) sensitivity and specificity of mean ADC values for differentiating EC from benign lesions were 93% (87-96%; I2 = 41.19%) and 94% (88-97%; I2 = 46.91%), respectively. The AUC (95% CI) of the SROC curve was 98% (96-99%). ADC values had good diagnostic accuracy for differentiating EC from benign lesions. In order to recommend ADC measurement for detecting endometrial lesions in routine clinical practice, more primary studies, especially trials and comparative studies including hysteroscopically-guided biopsy method, with larger sample sizes are still required.

Overuse of brain CT scan for evaluating mild head trauma in adults.

INTRODUCTION: CT scan is crucial in evaluating head trauma. However, its inappropriate use will cause unnecessary radiation exposure to patient and financial burden to health systems. Our aim is appraising amount of brain CT scans performed in our Emergency Department (ED) for evaluating mild head trauma which are not indicated according to four standardized guidelines as well as analyzing contributing factors. METHODS: This was a descriptive prospective study. We included randomly selected adult patients under 75 years old with minor head trauma evaluated by brain CT scan at our ED. For all patients, we completed a checklist including demographic data, mechanism of trauma, specialty of the requesting physician, and whether the patient meets the brain CT guidelines criteria. Brain CT overuse was defined as scans performed for patients without criteria of any of the standardized guidelines. RESULTS: We evaluated 170 patients. The mean age of patients was 38.38 ± 19.73 years old. The most common mechanism of trauma was falling (37.6%). The overall brain CT scan overuse was 15.3%. Most of the overused scans were performed in younger patients, and patient's age was inversely correlated to overuse. There was no significant difference based on the mechanism of trauma and the specialty of requesting physician. DISCUSSION: Our study accentuates the high frequency of brain CT scan overuse, leading to unnecessary radiation exposure and financial burden on healthcare systems. We emphasize that using a guideline for requesting brain CT scan can eliminate unnecessary scans along with detecting patients with important decisive damages.

Prognostic value of inflammatory biomarkers for predicting the extent of lung involvement and final clinical outcome in patients with COVID-19.

BACKGROUND: Inflammation plays a major role in coronavirus disease (COVID-19). Factors that convey information about the status of inflammation could predict disease severity and help identify patients prone to clinical deterioration. Here, we aimed to evaluate the predictive value of inflammatory markers on the extent of lung involvement and survival of patients with COVID-19. MATERIALS AND METHODS: Eighty patients with confirmed COVID-19 were enrolled. Demographic, clinical, and laboratory data were collected at admission. All patients underwent chest computed tomography (CT); the extent of lung involvement was assessed by a scoring system. Patients were followed up until death or discharge occurred. Logistic regression analysis was performed to evaluate the association of investigated variables with COVID-19-related death. The association between different variables and CT score was assessed using linear regression model. Receiver operator characteristic curve analysis was applied to identify the predictive value of inflammatory markers and CT score on survival. RESULTS: The mean age of patients was 54.2 ± 15.2 years; 65% were male. Increased neutrophil-to-lymphocyte ratio (ß =0.69, odds ratio [OR] =1.50), platelet-to-lymphocyte ratio (ß =0.019, OR = 1.01), and decreased lymphocyte to C-reactive protein ratio (LCR) (ß = -0.35, OR = 0.62) were significantly associated with a higher CT score and increased odds of death (P < 0.05). Lactate dehydrogenase level was also positively related with extensive lung involvement and death (ß =1.15, OR = 1.52, P < 0.05). The LCR threshold for identifying survivors from nonsurvivors was 0.53 (area under curve [AUC] =0.82, 78% sensitivity and 74% specificity). Lung involvement ≥50% on chest CT was an excellent predictor of death (AUC = 0.83, 81% sensitivity and 79% specificity). CONCLUSION: Daily-performed laboratory tests that represent inflammation have great value for predicting the amount of disease burden and risk of mortality. Moreover, their cost-effectiveness and feasibility turn them into ideal prognostic markers.

The Association of CT-measured Cardiac Indices with Lung Involvement and Clinical Outcome in Patients with COVID-19.

RATIONALE AND OBJECTIVES: Cardiac indices can predict disease severity and survival in a multitude of respiratory and cardiovascular diseases. Herein, we hypothesized that CT-measured cardiac indices are correlated with severity of lung involvement and can predict survival in patients with COVID-19. MATERIALS AND METHODS: Eighty-seven patients with confirmed COVID-19 who underwent chest CT were enrolled. Cardiac indices including pulmonary artery-to-aorta ratio (PA/A), cardiothoracic ratio (CTR), epicardial adipose tissue (EAT) thickness and EAT density, inferior vena cava diameter, and transverse-to-anteroposterior trachea ratio were measured by non-enhanced CT. Logistic regression and Cox-regression analyses evaluated the association of cardiac indices with patients' outcome (death vs discharge). Linear regression analysis was used to assess the relationship between the extent of lung involvement (based on CT score) and cardiac indices. RESULTS: Mean (±SD) age of patients was 54.55 (±15.3) years old; 65.5% were male. Increased CTR (>0.49) was seen in 52.9% of patients and was significantly associated with increased odds and hazard of death (odds ratio [OR] = 12.5, p = 0.005; hazard ratio = 11.4, p = 0.006). PA/A >1 was present in 20.7% of patients and displayed a nonsignificant increase in odds of death (OR = 1.9, p = 0.36). Furthermore, extensive lung involvement was positively associated with elevated CTR and increased PA/A (p = 0.001). CONCLUSION: CT-measured cardiac indices might have predictive value regarding survival and extent of lung involvement in hospitalized patients with COVID-19 and could possibly be used for the risk stratification of these patients and for guiding therapy decision-making. In particular, increased CTR is prevalent in patients with COVID-19 and is a powerful predictor of mortality.

Possible association of vitamin D status with lung involvement and outcome in patients with COVID-19: a retrospective study.

PURPOSE: Vitamin D deficiency has been reported as a key factor in the development of infectious diseases such as respiratory tract infections and inflammatory processes like acute respiratory distress syndrome. However, the impact of vitamin D on the severity and outcome of COVID-19 is still not fully known. Herein, we aimed to evaluate the prognostic role of serum vitamin D concentration on the extent of lung involvement and final outcome in patients with COVID-19. METHODS: Seventy-three subjects with confirmed diagnosis of COVID-19 were investigated in this study. The patients had been admitted to our academic hospital from February 28, 2020 to April 19, 2020. Demographic and clinical data, serum 25(OH)D levels, and findings of initial chest computed tomography were recorded. Linear and binary logistic regression, cox regression and ROC curve tests were used for statistical analysis. RESULTS: The mean age of patients was 55.18 ± 14.98 years old; 46.4% were male. Mean serum 25(OH)D concentration was significantly lower in the deceased (13.83 ± 12.53 ng/ mL compared with discharged patients (38.41 ± 18.51 ng/mL) (P < 0.001). Higher levels of 25(OH)D were associated with significantly less extent of total lung involvement (ß = - 0.10, P = 0.004). In addition, vitamin D deficiency [25(OH) D < 25 ng/mL] was associated with a significant increase in the risk of mortality (hazard ratio = 4.15, P = 0.04). CONCLUSION: This study suggests that serum vitamin D status might provide useful information regarding the clinical course, extent of lung involvement and outcome of patients with COVID-19. However, further studies with larger sample size are needed to confirm these findings.

A Multicenter Survey on the Trend of Chest CT Scan Utilization: Tracing the First Footsteps of COVID-19 in Iran.

BACKGROUND: Chest computed tomography (CT) scan has been used widely to diagnose COVID-19 in Iran. OBJECTIVES: To trace the footsteps of COVID-19 in Iran by exploring the trend in using chest CT scans and its economic impact on radiology departments. Methods: In this cross-sectional study, the number of imaging examinations from 33 tertiary radiology departments in 9 large cities of Iran was collected from September 23, 2019 to March 20, 2020 (Months 1 to 6) and the corresponding months in 2018-2019. RESULTS: A 50.2% increase was noted in the chest CT scan utilization in 2019-2020 compared to 2018-2019. This increase was +15%, +15%, +27%, +2%, +1% in Months 1-5 of 2019-2020, respectively. In Month 6 of 2019-2020, a 251% increase in the acquisition of chest CT scans was observed compared to the Month 6 of 2018-2019. Following negative balance of revenue from Month 1 to 5 with respect to the inflation rate, the total income in Month 6 was further 1.5% less than the same Month in 2018-19. CONCLUSION: The observed peak in chest CT utilization in Month 3 prior to the surge in Month 6 could be explained by the seasonal influenza. However, unawareness about an emerging viral disease, i.e. COVID-19, might have underutilized chest CT in Months 4 and 5 before the official announcement in Month 6. The unbalanced increase in the workload of radiology departments in the shortage of cardiothoracic radiologists with the simultaneous decrease in income initiated a vicious cycle that worsened the economic repercussions of the pandemic.

Management of Spine Trauma in COVID-19 Pandemic: A Preliminary Report.

BACKGROUND: COVID-19 was first identified in Iran in February 2020 and since then it spread rapidly through all over the country and soon after that it was reported as a pandemic. The current study presents a preliminary report of spine trauma management during COVID-19 pandemic. METHODS: A cross sectional study was designed to evaluate patients admitted for vertebral fractures with diagnosis of COVID-19 infection on February and March 2020. Analysis was made based on clinical and laboratory data along with the imaging findings from chest HRCT. RESULTS: Seven patients with spine trauma including five males and two females ranging from 14 to 59 years were diagnosed for COVID-19 infection through CT-scan findings. Except one, all other patients were asymptomatic for COVID-19 at the time of admission. In three cases the COVID diagnosis was made the day after arrival and in others after 10, 14 and 35 days. Five patients were treated surgically among whom four were admitted to ICU soon after the surgery. The mean ICU stay for operated patients were eight days and the mean hospital stay was 22.6 days. CONCLUSION: Proper diagnosis of COVID-19 is the keystone to protect both patients and health care providers. During the pandemic all admitted patients should be screened for COVID-19 infection. Unnecessary procedures for spine trauma patients should be avoided in order to reduce complications related to surgery and to preserve ICU beds.